Shoulder tendonitis is a common condition involving the irritation or inflammation of the tendons that connect muscle to bone around the shoulder joint. This typically affects the rotator cuff or the biceps tendon, which stabilize the arm bone within the shoulder socket. The condition frequently arises from overuse, particularly repetitive motions that involve raising the arm overhead, such as those performed in sports like swimming, tennis, or baseball. It can also be caused by jobs requiring frequent lifting or awkward arm positions, or sometimes a sudden, acute injury.
Immediate Pain Relief and Acute Management
When shoulder pain flares up, the initial focus should be on calming the irritated tendon and modifying activity to prevent further damage. Rest is the most immediate and effective step, requiring avoidance of any specific movement that causes pain, especially overhead reaching or lifting. However, complete inactivity is discouraged, as prolonged immobilization can lead to stiffness or a frozen shoulder.
Applying cold therapy helps reduce local inflammation and dull the pain signals. Ice packs should be wrapped in a thin towel and applied to the shoulder for 15 to 20 minutes at a time. This can be repeated every four to six hours during the first 48 to 72 hours of acute pain onset.
Over-the-counter Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), such as ibuprofen or naproxen, manage both pain and swelling in the short term. These medications work by blocking the body’s chemical pathways that promote inflammation. Consult a healthcare provider if you have any pre-existing conditions or are taking other medications. While these self-care measures offer immediate relief, they are a temporary strategy and should be followed by a professional assessment if the pain persists or worsens.
Professional Diagnosis and Medical Interventions
When initial self-care measures do not resolve the shoulder pain, seeking a professional medical diagnosis is required. The diagnostic process begins with a thorough physical examination where a clinician assesses the shoulder’s range of motion, checks for tenderness, and performs specific tests to pinpoint the injured tendon. They will also take a detailed history of your symptoms and the activities that aggravate the pain.
To confirm the diagnosis and rule out other structural issues, imaging studies are used. X-rays check for bone spurs or signs of arthritis, though they cannot directly visualize soft tissues. Ultrasound or Magnetic Resonance Imaging (MRI) provides views of the soft tissues, allowing the provider to assess tendon inflammation, thickening, or the presence of a partial or full tear.
For persistent pain that interferes with daily function or sleep, a physician may recommend medical interventions. Prescription-strength NSAIDs can be used for a limited time to control inflammation more aggressively. Corticosteroid injections, often a mixture of a steroid and a local anesthetic, can be administered directly into the inflamed tendon area. These injections provide significant, temporary anti-inflammatory effects and pain relief, which helps a patient begin physical therapy.
A physician limits the number of corticosteroid injections due to the potential for the steroid compound to weaken tendon tissue over time. If non-surgical methods fail, or if imaging reveals a significant, non-healing tendon tear, surgical options may be considered. Procedures range from arthroscopic debridement to remove inflamed tissue to a full tendon repair for chronic, severe cases.
The Role of Physical Therapy and Rehabilitation
Physical therapy focuses on restoring the shoulder’s natural movement and strength for long-term healing. The initial goals of rehabilitation center on pain reduction and restoring the full range of motion. This is achieved through passive range-of-motion exercises, where the therapist or the patient’s unaffected arm moves the injured arm without engaging the painful muscles.
The pendulum swing is one of the first exercises introduced, using gravity to encourage passive movement and reduce joint stiffness. As pain decreases, the program progresses to active range-of-motion exercises, where the patient moves the arm independently. The next phase involves strengthening the rotator cuff muscles, which stabilize the shoulder joint, and the periscapular muscles around the shoulder blade.
Strengthening exercises often involve low-resistance tools, such as light dumbbells or elastic resistance bands, for internal and external rotation movements. The focus is on controlled, high-repetition movements to encourage blood flow and promote healing within the often poorly vascularized tendon tissue. Scapular stabilization exercises, like squeezes or resistance band rows, are integrated to improve posture and control of the shoulder blade, which provides a stable base for arm movement. Incorporating eccentric strengthening, which focuses on the lengthening phase of a muscle contraction, improves tendon health and tolerance to load.
Strategies for Long-Term Prevention
Once acute pain has resolved and strength is restored, maintaining shoulder health requires adopting long-term strategies to prevent recurrence. A primary focus should be on optimizing your workspace and daily activities through ergonomic adjustments. Ensuring your computer monitor is at eye level and your arms are supported while typing reduces strain on the upper back and shoulder tendons.
Proper technique during physical activity is important, whether lifting heavy objects or engaging in sports. Learning to lift with the legs and keeping heavy items close to the body minimizes the load placed on the shoulder joint and rotator cuff. For athletes, refining throwing or swinging mechanics with a coach can prevent the repetitive strain that initially caused the tendonitis.
Maintaining good posture is important, especially for those who spend many hours sitting. Slouching or hunching forward places constant tension on the shoulder structures. Incorporating simple daily maintenance routines, such as light stretching and the strengthening exercises learned in physical therapy, helps maintain the flexibility and muscle balance necessary to keep the shoulder joint stable and resilient.